Month: October 2012

Fuel Injection Death

mary Zeman via Melissa Bryan posted about an accident where a student nurse in training (3rd day on the job) administered a feeding bag of coffee and milk instead of a unit of blood. http://goo.gl/otI4e  For starters, I don’t think coffee mixed with milk looks like a unit of blood. Nevertheless, in Mary’s post I explained what I think likely happened, e.g., COD.

Nutritional specialist Dr. Armando Carreir told the network that Ribeiro’s death “would have been as if [she] was suffocating.” from HuffPuff: http://goo.gl/euhoM

So how can the patient be suffocating? It was likely due to pulmonary edema (fluid in the lungs). So how did the patient get fluid in the lungs? Not knowing the exact mixture of coffee and milk, I’m guessing that the mixture was hypertonic. Let me back up and talk briefly about intravenous (IV) pharmaceuticals.

When you adminster a large volume of fluids IV, it has to be at physiologic pH (7.4), isotonic, and iso-oncotic. There are cases where you can give a fluid that is not one of these three properties to correct for the patients condition.

Tonicity

From the Wiki:

Tonicity is a measure of the osmotic pressure gradient (as defined by the water potential of the two solutions) of two solutions separated by a semipermeable membrane. It is commonly used when describing the response of cells immersed in an external solution. Like osmotic pressure, tonicity is influenced only by solutes that cannot cross the membrane, as only these exert an osmotic pressure. Solutes able to freely cross the membrane do not affect tonicity because they will always be in equal concentrations on both sides of the membrane.

There are three classifications of tonicity that one solution can have relative to another. The three are hypertonic, hypotonic, and isotonic. There’s a good figure in the Wiki that shows what happens to the blood cells in the three types of tonicity. 

http://en.wikipedia.org/wiki/Isotonicity#Isotonicity

Colloid osmotic pressure (COP) or Oncotic pressure

COP  is an osmotic pressure caused by protiens in the vasculature which opposes the hydrostatic pressure. The normal COP of plasma is between 20-25 tor.  An increase in COP above normal levels will lead to water leaving the interstitium and entering the vascular space.  http://en.wikipedia.org/wiki/Oncotic_pressure

Here’s a great guide on IV fluids for nurses: http://goo.gl/bilmc

Image Source: http://goo.gl/jrwtK

#ScienceEveryday when it isn’t #ScienceSunday

Buzz about when natural remedies become real medicine

Buddhini Samarasinghe ,others, and I often mention how alternative medicine becomes medicine when it’s rigorously tested. Here’s an example from the The University of Chicago . Chih-Pin Chuu et al, in Dr. Richard Jones’ lab report how Caffeic Acid Phenethyl Ester (CAFE) suppress cell proliferation of prostate cancer cells. CAPE is the active ingredient in beehive propolis (see below). They started with cancer cells in vitro and then moved to a mouse model.

From the University of Chicago news blurb (http://goo.gl/vtJ22): 

But if CAPE were to truly make the crossover from holistic remedy to clinical option, the scientists would also have to demonstrate how the compound freezes cancer cells in a non-proliferative state. Enter the micro-western array, the innovative proteomics technique first described in 2010 by Jones and colleagues. 

Once they found their target pathway from the micro-western array, they over-express components of those pathways to block the effect of CAPE. This kind of follows my diet post earlier today (http://goo.gl/vlUWT). CAPE makes the cancer cells think there is no nutrients available. There is mention of patent issues in the article, i.e., it would be hard to get a drug company to pay for the clinical trials on this because propolis cannot be patented. For more on that issue, check out my Bench to Bedside post. http://goo.gl/xpu7W

Caffeic acid phenethyl ester suppresses the proliferation of human prostate cancer cells through inhibition of p70S6K and Akt signaling networks.

Chuu CP, Lin HP, Ciaccio MF, Kokontis JM, Hause RJ Jr, Hiipakka RA, Liao S, Jones RB.

Cancer Prev Res (Phila). 2012 May;5(5):788-97.  http://goo.gl/iwFGW

In searching for a good eye catching photo to go along with the article, I realized that the image in the news blurb is a stock image from Wikipedia. It was also used in this interesting article.

Image of propolis, the sticky resin that bees line their hive with. In a PLosONE article Michael Simone-Finstrom and Marla Spivak report it’s anti-fungal properties.  http://goo.gl/duvSC

#ScienceEveryday  when it isn’t #ScienceSunday